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Abstract
Introduction To investigate optimal substage of lymph node metastasis in the FIGO staging system for cervical cancer.
Methods Patients with early-stage cervical cancer who were surgically confirmed lymph-node metastases between 2008 and 2015 were analyzed for cancer-specific survival and compared with contemporaneous stage IIB, IIIA and IIIB patients.
Results A total of 2098 patients were included, comprising of 584 cases who were surgically confirmed node-positive with FIGO 2009 stage IA2 to IIA2 (cohort A) and 1514 cases with stage IIB to IIIB (cohort B). The median follow-up time was 62 and 48 months for cohort A and B, respectively. Patients in cohort A had significantly more favored overall survival than stage IIB (P = 0.003), IIIA (P <0.001) and IIIB (P < 0.001) patients. In cohort A, initial FIGO 2009 stage, the number of metastatic nodes and tumor size were independent prognostic factors for overall survival. In cohort B, lymph node metastases significantly decreased survival in patients with stage IIB (P=0.007), but not in patients with stage IIIA (P=0.347) or IIIB (P=0.486) disease. When mergerd node-positive IIB patients into cohort A, the 5-year overall survival were 81.3%, 78.1%, 68.8% and 64.3% for stage IIB (node-negative), regrouped cohort A (all node positive cases with FIGO stage IA2 to IIB), IIIA and IIIB patients, respectively (P < 0.001).
Conclusion/Implications The prognosis of early-stage cervical cancer with nodal metastases is significantly better than that of stage IIIA and worse than IIB. The findings support to stratify these patients into a new substage IIC in FIGO staging system.
